Oral ketamine for depression: An updated systematic review
Shakila Meshkat, Sipan Haikazian, Joshua D. Di Vincenzo, Farhan Fancy, Danica E. Johnson, David C J Chen-Li, Roger S McIntyre, Rodrigo B. Mansur, Joshua D. Rosenblat
World Journal of Biological Psychiatry January 18, 2023 DOI: 10.1080/15622975.2023.2169349 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Randomized Open-label Case report Peer reviewed |
|---|---|
| Sample size | 2,336 |
| Population | Patients with unipolar or bipolar depression |
| Interventions | oral ketamine esketamine r-ketamine |
| Dose | 0.5 to 1.25 mg/kg |
| Topics | Depression Esketamine Ketamine |
| Citations | 61 |
| Key findings | Preliminary evidence suggests oral ketamine has potential antidepressant effects, but the evidence is limited by few randomized trials and high risk of bias. |
Abstract
Abstract
Objectives: Ketamine is a glutamate N-methyl-D-aspartate receptor antagonist that can be used to treat major depressive disorder by single or repeated infusions. However, the accessibility and scalability of oral ketamine make it preferred over intravenous ketamine. In this systematic review, we aim to evaluate the efficacy, tolerability, and safety of oral ketamine, esketamine and r-ketamine for unipolar and bipolar depression.
Materials and Methods: Electronic databases were searched from inception to September 2022 to identify relevant articles.
Results: Twenty-two studies, including four randomized clinical trials (RCTs), one case series, six case reports, five open-label trials and six retrospective chart review studies involving 2336 patients with depression were included. All included studies reported significant improvement following ketamine administration. Ketamine was well tolerated without serious adverse events. However, RCTs had a high risk of bias due to analysis methods and adverse events monitoring. Ketamine dosage varied from 0.5 to 1.25 mg/kg. The frequency of administration was daily to monthly. Several important limitations were identified, most notably the small number of RCTs.
Conclusions: Taken together, preliminary evidence suggests the potential for antidepressant effect of oral ketamine. However, further research with large sample size and long follow-up period is needed to better determine the antisuicidal effect and efficacy in treatment-resistant depression.